Sunday, April 11, 2010

Okay, all you armchair neurologists, I'm on call this weekend, and it's time for you to help me with DR. GRUMPY'S CHALLENGING PATIENT.

Here's the story:

Mrs. Smith was mugged outside Local Mall yesterday, in an event witnessed by several bystanders. Mr. Scumbag hit her over the head with a crowbar (she'll be fine, don't worry) knocking her out, and grabbing her purse (he's already been caught).

So she was admitted to Grumpy Hospital. And the admitting internist wrote in the chart:

That's a hard one, Doctor Grumpy. Is there anything in the patient history that could explain it?Here, this is for you: a ship missing for 200 years has resurfaced.http://ca.news.yahoo.com/s/capress/100410/world/us_warship_resurfaces

Patient lost consciousness initially pursuant to being struck with the crowbar. She regained consciousness in the field but lost consciousness upon arrival in the ED when, after 5 seconds in his presence, she realized Dr. Internist's complete lack of critical thinking skills.

Just prior to the mugging, Mr. Scumbag had gone to the mall's head shop and bought several vials of Rush, which he'd then consumed in the mistaken belief that they were energy drinks. While in the process of hitting Mrs. Smith over the head with a crowbar, he breathed in her face.

This may be a reaction to the internist being previously fussed at by a specialist. "How dare you put a conclusion in the notes that only a specialist like me can determine".Internist then gets childish and writes the note indicated. I wonder how many other silly notes this doctor has written?

She lost consciousness due to a sudden drop in blood pressure. Mr. Scumbag happened to be nearby when this occurred, and he happened to still be carrying the crowbar he'd just used to extricate a couple of children who'd gotten trapped in the Dance Dance Revolution machine at the arcade. Thinking fast, he swung the crowbar at her head, in the hopes that he could startle her and the sudden rush of adrenalin would revive her. When this didn't work, he grabbed her purse so he could look inside and find her name and relevant medical information in order to help the paramedics. And that's when this Good Samaritan was unjustly arrested and faces the loss of his reputation and the ruination of the charity projects to which he's devoted his life. And all to help some woman who'd just been caught trying to shoplift a copy of "Mein Kampf" from Waldenbooks.

To be fair, Admitting Internist was probably on day #5 straight in a row, exhausted and sleep-deprived at 3AM, and cursing his miserable existence -- not really giving a crap about whether or not Smartass Neurologist would see his writing, find it amusing, and post it on the internet for all to see.

Dr Grumpy - Try this as an experiment to help with the answer: hit Dr. Internist in head w crowbar; if he loses consciousness, that may be the answer. If he does NOT lose consciousness, I'd suggest hitting him in the head repeatedly to verify that it's NOT the answer. If he still remains conscious, he needs a neurology consult.

Blame it on an earthquake - which caused uncontrollable movement - ending up in the patient bumping her own head against the crowbar the scumbag had just bought - which resulted in dropping her purse - which the scumbag was holding onto so that both of them could survive on the linty mints in the purse and the 1/2 bottle of water in case the mall collapsed....in other words, he was framed copper!

The woman had her stash of coupons, one in particular was 50% off canned cat food, tucked safely away in her purse. The shock of having someone take her purse with her treasure inside, was too much for her to bear, so she passed out in an effort to protect her mind from the horror. Look into it further, you will probably find it was double coupon day, which makes the tragedy all the more heinous.

Bless Dr. Intern's heart. He must have slept late on the day of the TBI neuro lecture. I concur on the suggestion of an empirical case study with Dr. Intern being the case. I hope you didn't have to go in just for this one.

Thankfully, I'm not going into internal medicine. I just get the feeling that a large chunk of Doc Grumpy's readers aren't familiar with the concept of (1) the lucid interval during the night when reason and logic cease to exist, and (2) crappy attendings who like to pan-consult regardless of what time it is.

I'm a resident, and in my limited experience I've seen enough of both to be able to guess that this is one or the other. I understand this is how Doc Grumpy likes to vent, and my initial reaction is to laugh, too, but the peanut gallery in the comments seems to consist of a few knowing smirks scattered in between jeers from people who haven't a bloody clue what is going on. Sure is a tough place with tough guys, these Internets.

Eh, no doubt he worded something wrong. He obviously knows that the crow bar caused her to lose consciousness, he just wants to find out if there are underlying problems that will surface later. But it does make for good blog fodder.

PhilYes, the internet can be a harsh world sometimes. But has it occurred to you that perhaps MOST of the people reading this and leaving comments actually DO know what it's like to go non-stop for many hours too long? Why is it that only Dr. Grumpy is the one with a pass on venting? Why do you think we read this? Some of us like knowing that others have it rough too. So, yeah, the internet is a tough place. So is life. Let us vent vicariously.

As for the above comments, I applaud everyone's creativity. However, the cat food coupons on double coupon day is CLEARLY reality. I, too, have seen a similar incident and can verify its accuracy.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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